Fat necrosis - breast

Case contributed by Garth Kruger
Diagnosis almost certain

Presentation

Mammogram images of the left breast in a patient who was treated for carcinoma with surgery two years prior.

Patient Data

Age: 60 years
Gender: Female
mammography

Post therapy changes to the left breast with surgical scarring visible with a typical parenchymal distortion related to the surgical scar.

Note the subtle lucencies in the subareolar breast tissue. They are the early changes of fat necrosis.

Two years later

mammography

The typical serpiginous circumferential calcification of fat necrosis.

Note how the skin changes from radiation around the nipple have almost disappeared two years later.

Retroareolar

ultrasound

The lesions are the lesions shown on the mammogram images. The thin rim of calcification is visible and the necrotic fat is slightly echogenic. This is not a tumor and no work up is indicated.

Case Discussion

Another case to bring home the point that fat necrosis in the breast can and does change with time. Do not let the early peripheral calcifications confuse you with possible DCIS. Don't be alarmed by the protean appearance of fat necrosis on ultrasound; invariably the history and mammogram will guide you. The lucencies are invariably seen on previous mammograms if they are available and good quality.

Compare with case rID 18655.

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